What will it really take to end AIDS? The Skoll World Forum and Impatient Optimists have co-produced a blog series to answer this question. We'll publish two posts/day over the next three days.
According to the latest report by UNAIDS, new HIV infections have dropped more than 50% in 25 low and middle-income countries. Last week, U.S. Secretary of State Hillary Clinton unveiled what she described as a blueprint for an ‘AIDS-Free Generation’. There may not be consensus on how best to tackle the AIDS pandemic, but it is impossible to doubt the depth of global commitment. However, while we celebrate this progress, we must still confront the challenges ahead. What will it really take to end AIDS? We asked some of the world's leading experts and innovators—representing the UN Global Plan, mothers2mothers, (RED), Riders for Health, ONE Campaign, the Center for Gender Health and Equity, and the Gates Foundation—to highlight key challenges moving forward, and how we can overcome them.
Gender inequality is HIV’s best friend
Fortunately, the converse is also true – gender equality is HIV’s nemesis. And by fighting HIV through advancement of gender equality, we reap all kinds of additional benefits.
Women account for slightly more than half of all people living with HIV, and the majority contract it through sex with long-term partners. Young women account for nearly 75 percent of infections among people ages 15-24 in sub-Saharan Africa.Girls who bear the brunt of two classic symptoms of gender oppression — being married off young or kept out of school — are particularly vulnerable to HIV. Gender violence – whether it’s rape used as a weapon of war, physical violence in the home that takes away women’s power to suggest condom use, or emotional violence that keeps women silent and untreated if they are diagnosed with HIV – is like gasoline to the spread of HIV.
Some of the most promising solutions to the spread of HIV reside in stripping away the layers of oppression from the lives of women and girls. Access to comprehensive, rights-based sexual and reproductive health services is a critical first step. Such care allows a woman to control the number and spacing of her children, and to confidentially test her HIV status. It gives her tools to protect herself – tools like female condoms, effective in preventing both HIV and unintended pregnancy. And such care gives her the ability to stay healthy during pregnancy and childbirth, regardless of her HIV status. By linking these services together and infusing them with a respect for the dignity of each woman and girl, we greatly improve the likelihood that she will benefit from the highest attainable standard of health care.
If we fail to understand how deeply HIV’s roots are intertwined with the violation of women’s rights we may end up winning battles but we are certainly losing the war.
Efforts beyond the formal health sector also present possibilities.
Programs such as microfinance and cash transfers that bolster economic opportunity and educational access for women and girls are proven to reduce their risk for HIV. Outreach to men and boys, to combat gender violence and change gender norms, is also creating impact. Weakening HIV’s grip on women and girls by improving their legal, social, and economic status is absolutely essential.
If we fail to understand how deeply HIV’s roots are intertwined with the violation of women’s rights we may end up winning battles but we are certainly losing the war. The woman living with HIV who is mistreated by health care providers is unlikely to seek tools to prevent a pregnancy, or care during a pregnancy. Condom promotion is useless where violence takes away a woman’s right to protect herself. Maternity wards that put multiple women in each bed and lack basic life-saving supplies help drive women to give birth at home – endangering their lives and leaving them untested for HIV.
The global AIDS response must promote:
- Women’s rights: HIV depends on gender inequalities that prevent women from supporting themselves financially and making decisions about their sexual activity. Women’s rights need to be recognized, respected, and promoted if we are going to end HIV.
- Women’s participation: The clearest way to ensure that policies and programs are advancing gender equality is to include women in decision making. Living these realities, they are best equipped to pinpoint what meets their needs. There are women’s rights groups in every country on the planet, and we cannot accept any more excuses for not including women at the table.
- Woman-controlled prevention: We have to increase funding and policy support for female condoms, in additional to male condoms. They must be a mandatory component of all programs that prevent and treat HIV.
- Integration of sexual and reproductive health: HIV, family planning, and maternal health are intrinsically linked, and services need to reflect that.
Gender equality is AIDS’ nemesis. We cannot create an AIDS-free generation without it.